104例血液病患者自体外周造血干细胞移植早期感染的临床分析  

Clinical analysis of early infections after autologous hematopoietic stem cell transplantation in 104 hematopathy patients

作　　者：熊艺颖[1] 刘林[1] 陈建斌[1] 唐晓琼[1] 肖青[1] 张红宾[1] 王建渝[1] 王欣[1] 王利[1] 

机构地区：[1]重庆医科大学附属第一医院血液内科,400016

出　　处：《检验医学与临床》2017年第9期1209-1212,共4页Laboratory Medicine and Clinic

基　　金：国家自然科学基金青年基金项目(81100358);重庆市卫生局资助项目(2013-2-023)

摘　　要：目的回顾性分析104例血液病患者行自体外周造血干细胞移植后早期感染(30d内)的发生情况及危险因素。方法收集患者临床资料,记录移植早期感染的发生率、病原菌分布及治疗情况,对患者的性别、年龄、疾病类型以及粒细胞缺乏时间等因素进行回顾性分析。结果 100例患者造血重建,73例(70.19%)在移植后早期发生感染,未发生感染相关死亡。共分离25株病原菌,包括革兰阴性菌10株(40.00%),革兰阳性菌7株(28.00%),真菌8株(32.00%)。粒细胞缺乏时间大于10d是移植后早期感染以及真菌感染发生的危险因素(P分别为0.008和0.044),而性别、年龄及疾病类型对患者的早期感染无显著影响(P<0.05)。结论粒细胞缺乏时间大于10d可能增加自体外周造血干细胞移植后早期感染风险;加速造血重建,缩短粒细胞缺乏时间,预防感染并经验性抗感染治疗,可能降低早期感染的发生率及病死率,提高移植疗效以及患者生存质量。Objective To investigate the clinical etiological characteristics and risk factors of early infections （within 30 days） after autologous hematopoietic stem cell transplantation （auto-HSCT） in 104 hematopathy patients.Methods The patients′ clinical data were collected.Within 30 days after auto-HSCT,occurrence rate and pathogens distribution of early infections,and treatment and outcome of patients were detected and recorded.The factors related to early infections following auto-HSCT,including sex,age,disease and duration of agranulocytosis,were analyzed retrospectively.Results One hundred patients obtained hematopoietic reconstruction,and 73 patients（70.19%） developed infections with no death at early stage after auto-HSCT.Total of 25 strains of pathogens were isolated,and 10 strains of gram-negative bacteria （40.00%）,7 strains of gram-positive bacteria（28.00%） and 8 strains of fungal （32.00%）.The length of agranulocytosis （more than 10 days） was a risk factor for early infections including fungal infections after auto-HSCT （P values were 0.008 and 0.044 respectively）.The sex,age and disease had not significant effect on patients′ early infections after auto-HSCT （all P-values were less than 0.05）.Conclusion It may increase the risk of early infections after auto-HSCT when the length of agranulocytosis is more than 10 days.Through shortening the duration of agranulocytosis by accelerating hematopoietic recovery and prophylactic and empirical anti-infective treatments,they may reduce the early infection rate and mortality after auto-HSCT and improve the curative effect of auto-HSCT and the life quality of patients.

关 键 词：自体外周造血干细胞移植 感染 危险因素 

分 类 号：R457[医药卫生—治疗学]